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Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series
Background. Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We eva...
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| Published in: | British journal of anaesthesia : BJA 2017-02, Vol.118 (2), p.182-189 |
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| container_title | British journal of anaesthesia : BJA |
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| creator | Groeben, H. Nottebaum, B. J. Alesina, P. F. Traut, A. Neumann, H. P. Walz, M. K. |
| description | Background. Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours.
Methods. Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).
Results. No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024).
Conclusions. Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study. |
| doi_str_mv | 10.1093/bja/aew392 |
| format | article |
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Methods. Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).
Results. No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024).
Conclusions. Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/aew392</identifier><identifier>PMID: 28100521</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adolescent ; Adrenal Gland Neoplasms - physiopathology ; Adrenal Gland Neoplasms - surgery ; Adrenergic alpha-Antagonists - adverse effects ; Adrenergic alpha-Antagonists - therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Female ; Hemodynamics - drug effects ; Humans ; Male ; Middle Aged ; Pheochromocytoma - physiopathology ; Pheochromocytoma - surgery ; Propensity Score ; Young Adult</subject><ispartof>British journal of anaesthesia : BJA, 2017-02, Vol.118 (2), p.182-189</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2017</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-d64dc21e44648ebfb15a81e96dc6cead81dc56bf2b58032c2f9d1869458fdc203</citedby><cites>FETCH-LOGICAL-c353t-d64dc21e44648ebfb15a81e96dc6cead81dc56bf2b58032c2f9d1869458fdc203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,1591,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28100521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Groeben, H.</creatorcontrib><creatorcontrib>Nottebaum, B. J.</creatorcontrib><creatorcontrib>Alesina, P. F.</creatorcontrib><creatorcontrib>Traut, A.</creatorcontrib><creatorcontrib>Neumann, H. P.</creatorcontrib><creatorcontrib>Walz, M. K.</creatorcontrib><title>Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Background. Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours.
Methods. Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).
Results. No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024).
Conclusions. Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.</description><subject>Adolescent</subject><subject>Adrenal Gland Neoplasms - physiopathology</subject><subject>Adrenal Gland Neoplasms - surgery</subject><subject>Adrenergic alpha-Antagonists - adverse effects</subject><subject>Adrenergic alpha-Antagonists - therapeutic use</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Female</subject><subject>Hemodynamics - drug effects</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pheochromocytoma - physiopathology</subject><subject>Pheochromocytoma - surgery</subject><subject>Propensity Score</subject><subject>Young Adult</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp9kM1KxDAURoMozji68QEkG0GEOknatI07GfyDAV3oUkp-bp2O7aQm7cg8li_iMxnp6NLVhcv5zuIgdEzJBSUinqqlnEr4iAXbQWOaZDRKs4zuojEhJIuIoGyEDrxfEkIzJvg-GrGcEsIZHaOXR3CVbcHJrloD_vqMHGhoO-uwqq1-kwZwtcLtQoLVC2cbqzedbST2vXsFt7nEcoWt8uDWwWBXssZaesDhUYE_RHulrD0cbe8EPd9cP83uovnD7f3sah7pmMddZNLEaEYhSdIkB1UqymVOQaRGpxqkyanRPFUlUzwnMdOsFIbmqUh4XoYhiSfobPC2zr734LuiqbyGupYrsL0vAkx5xgVJA3o-oNpZ7x2UReuqRrpNQUnxk7MIOYshZ4BPtt5eNWD-0N9-ATgdANu3_4m-AajIgHE</recordid><startdate>20170201</startdate><enddate>20170201</enddate><creator>Groeben, H.</creator><creator>Nottebaum, B. J.</creator><creator>Alesina, P. F.</creator><creator>Traut, A.</creator><creator>Neumann, H. P.</creator><creator>Walz, M. K.</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170201</creationdate><title>Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series</title><author>Groeben, H. ; Nottebaum, B. J. ; Alesina, P. F. ; Traut, A. ; Neumann, H. P. ; Walz, M. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-d64dc21e44648ebfb15a81e96dc6cead81dc56bf2b58032c2f9d1869458fdc203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adrenal Gland Neoplasms - physiopathology</topic><topic>Adrenal Gland Neoplasms - surgery</topic><topic>Adrenergic alpha-Antagonists - adverse effects</topic><topic>Adrenergic alpha-Antagonists - therapeutic use</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Female</topic><topic>Hemodynamics - drug effects</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pheochromocytoma - physiopathology</topic><topic>Pheochromocytoma - surgery</topic><topic>Propensity Score</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Groeben, H.</creatorcontrib><creatorcontrib>Nottebaum, B. J.</creatorcontrib><creatorcontrib>Alesina, P. F.</creatorcontrib><creatorcontrib>Traut, A.</creatorcontrib><creatorcontrib>Neumann, H. P.</creatorcontrib><creatorcontrib>Walz, M. K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Groeben, H.</au><au>Nottebaum, B. J.</au><au>Alesina, P. F.</au><au>Traut, A.</au><au>Neumann, H. P.</au><au>Walz, M. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2017-02-01</date><risdate>2017</risdate><volume>118</volume><issue>2</issue><spage>182</spage><epage>189</epage><pages>182-189</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Undefined-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>Background. Mortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours.
Methods. Haemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI).
Results. No difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024).
Conclusions. Only a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>28100521</pmid><doi>10.1093/bja/aew392</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adrenal Gland Neoplasms - physiopathology Adrenal Gland Neoplasms - surgery Adrenergic alpha-Antagonists - adverse effects Adrenergic alpha-Antagonists - therapeutic use Adult Aged Aged, 80 and over Female Hemodynamics - drug effects Humans Male Middle Aged Pheochromocytoma - physiopathology Pheochromocytoma - surgery Propensity Score Young Adult |
| title | Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series |
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